Making Insulin Treatment Safer (MITS) Helping clinicians co-produce good practice with patients and fellow professionals

Treating diabetic patients in hospital is complex and requires judgement. Writing insulin prescriptions is a difficult task that is prone to mistakes and resistant to improvement efforts. Errors can cause harm and lengthen patients’ hospital stay.

Research carried out by South Eastern Health and Social Care Trust found that errors in prescribing insulin are due to faulty systems rather than individual mistakes. The Making Insulin Treatment Safer (MITS) intervention was developed to improve prescribing by educating doctors, nurses and pharmacists, and encouraging patients to be more involved.

There is usually no single right way to treat hospitalised patients with insulin. MITS educates clinicians to act wisely when there is no single answer, and encourages them to work collaboratively and promote a blame-free culture. MITS supports two-cycle reflective learning: helping clinicians act reflectively in the moment; and helping them reflect on experience after the moment and plan future actions.

A comprehensive, flexible set of procedures were developed, which were adapted to online learning in response to the COVID-19 pandemic. Over 50 ‘debriefers’ have been trained to conduct reflective debriefs with clinicians. These involve trainee prescribers spending up to 30 minutes one-to-one with a debriefer, empowering reflective conversation. Over 300 clinicians have been trained, either using the MITS debriefs or the MITS reflective toolkit.

The intervention puts patients at the centre and 14 of the debriefers are patient advocates.

MITS has been widely disseminated in Northern Ireland and is now included in the basic prescribing curricula of all Northern Ireland health professionals.

Contact information

For more information about this project, please contact Professor Timothy Dornan, Professor of Medical Education, South Eastern Health and Social Care Trust.